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Medicare Claims Analyst Resume Example

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MEDICARE CLAIMS ANALYST
Work History
Medicare Claims Analyst, 07/2014 to 09/2016
Bottom Line Systems – Crescent Springs, KY
  • Confidently handled denials/appeals for outpatient/inpatient claims billed incorrectly or under paid.
  • Posted and adjusted payments received from insurance carrier.
  • Submitted electronic/paper claim documentation for timely filing.
  • Interacted with providers and other medical professionals regarding billing/procedures/government regulations.
  • Reviewed incorrectly billed claims to identify more appropriate coding based on CMS Regulations and guidelines.
  • Researched CPT and ICD-9/ ICD-10 coding discrepancies for compliance and reimbursement accuracy.
  • Actively maintaining knowledge of CPT/ICD-9/ICD-10 coding principles, government regulation, CMS guidelines, billing processes, coding requirements, through continuing education and certification renewals.
Claim Researcher , 12/2011 to 07/2014
Omnicare Inc – Cincinnati, OH
  • Rectified problems concerning coverage/billing to ensure pharmacy needs were properly met for patient/facility.
  • Verified patient eligibility, coverage and claim status with insurance carrier.
  • Trained new hires on system/programs/position requirements until full understanding of all processes.
  • Obtained prior authorizations for coverage on patient\'s medications.
  • Managed collection against estate of deceased patient.
  • Evaluated financial status to appropriately set payment plans for patient.
  • Treated patients, family members, pharmacy/facility staff and carrier reps with courteous, professional manner.
  • Offered detailed explanation of plan coverage/processes, above job description, to provide excellent customer service.
  • Acknowledged by management; received customer appreciation regularly.
  • Awarded multiple times for excellent customer service.
Professional Summary
Medical Billing and Coding Specialist with 7 years experience. Strong ability to identify denied/under paid claim items needing appeal/correct claim. Organized professional able to adapt to changes within the Billing and Coding profession. Knowledge and experience to interpret contract language between provider/carrier.
Skills
  • Education, Training and broad knowledge of ICD-9/ICD-10, CPT procedure coding, Revenue codes, Condition codes, DRG assignments, Medicare PC pricers
  • Inpatient and outpatient coding proficiency
  • Experience with Traditional Medicare, Medicare Advantage, Commercial, RX coverage plans
  • HCPCS Coding Guidelines
  • Composed and professional demeanor with excellent customer service skills
  • Billing and collection procedures experience
  • DRG assignment, PC Medicare pricer training, including outpatient grouping and codes
  • Medical terminology knowledge, ability to read and understand medical records, interpret contract language
Education
Medical Claims and Billing degree : 2009
U.S. Career Institute -
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Resume Overview

Companies Worked For:

  • Bottom Line Systems
  • Omnicare Inc

School Attended

  • U.S. Career Institute

Job Titles Held:

  • Medicare Claims Analyst
  • Claim Researcher

Degrees

  • Medical Claims and Billing degree : 2009

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